MEDICARE: MS. KIMBERLY D AUSTIN PULEIO LICSW LADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	000367	VT
2	1041C0700X	Clinical Social Worker	089-0001092	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497812739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY D AUSTIN PULEIO LICSW LADC

Provider Business Mailing Address
First Line	:	101 COMMONWEALTH AVE
Second Line	:
City	:	HYDE PARK
State	:	VT
Zip	:	05655-9411
Country	:	US
Telephone Number	:	802-888-3314
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 MAIN ST
Second Line	:
City	:	HYDE PARK
State	:	VT
Zip	:	05655
Country	:	US
Telephone Number	:	802-888-6215
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	06/12/2009

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